Healthcare Provider Details

I. General information

NPI: 1831113372
Provider Name (Legal Business Name): PAMELA J. KOWAL M.S. LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA J. HENKEL

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E. CHESTNUT ST.
STILLWATER MN
55082
US

IV. Provider business mailing address

PO BOX 574
STILLWATER MN
55082
US

V. Phone/Fax

Practice location:
  • Phone: 651-434-0466
  • Fax:
Mailing address:
  • Phone: 651-434-0466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1066
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number616-124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: